Outbreak management in healthcare facilities

Isolate all symptomatic patients. Cohort confirmed cases as required.

Close doors to isolation/cohort areas if required (is it safe to close doors?).

Consider curtain use and portable air purifiers as necessary.

Place transmission-based precautions signage on entry to isolation/cohort areas indicating recommended measures.

Ensure appropriate placement of readmitted patients who are contacts (where recommended).

Close the ward or bay as instructed by executive and IPC professional.

Limit non-essential visitors (where indicated and in consultation with IPC service).

Discharge patients home if safe to do so (ensure discharge summary and patient/carer are alert for any relevant signs and symptoms, actions to take and any ongoing recommended control measures).

Avoid transfer to other healthcare facilities, unless advised and agreed by IPC service.

Avoid patient transfer from affected ward/bay to unaffected another ward/bay. If essential, confirm with receiving area that they are prepared to continue IPC measures until patient is de-isolated.

Encourage staff to stay home when sick. Refer to the Australian Guidelines for the Prevention of Infection in Healthcare 4.2.2 Exclusion periods for healthcare workers with acute infections and your local health facility staff exclusion guidance.

Ensure all staff are vaccinated as indicated. Where indicated by IPC service, dedicate staff to the care of cases for the duration of the incident.

Consider strategies for staff working across multiple clinical areas e.g., phlebotomists, physiotherapists to reinforce appropriate IPC measures.

Alcohol-based hand rub is available at point of care. Soap, water, and paper towel is also available, especially for gastro outbreaks.

Reinforce the 5 moments of hand hygiene during patient care (e.g. remove gloves in patient zone to perform HH as required and reapply new gloves).

Ensure sufficient and appropriate PPE is available for staff to don before entering the patient care area. Doff PPE in a doffing zone adjacent to the patient care area and perform hand hygiene appropriately.

Check hand hygiene auditing data for the affected ward/unit to ensure ward compliance is acceptable. Consider further education specific to hand hygiene if not adequate.

Increase auditing of standard and transmission-based precautions - active observation can increase compliance with IPC practices.

Consider universal mask use during acute respiratory infection outbreaks as source control.

Assess for possible aerosol transmission of organism. Reduce and/or remove equipment that may contribute to aerosol environmental contamination, e.g. portable fans.

Identify modifiable risk factors during high contamination procedures to reduce healthcare worker, equipment, and environmental contamination.

Clean and declutter the ward and clinical space.

Increase frequency of cleaning according to IPC professional instructions, as per provisions in the Management of environmental cleaning services guideline. Clarify environmental cleaning roles within the care team. Consider cleaning of heating, ventilation and air conditioning system, and food preparation areas.

Ensure adherence to cleaning and disinfection of shared patient equipment.

Allocate dedicated patient care equipment for isolation and cohort areas.

Consider screening all patients in the ward in consultation with IPC.

Consider environmental sampling for environmentally hardy organisms. Consult with laboratory staff.

Consider ribotyping C. difficile specimens during this phase to determine if the strains are the same and/or if a hypervirulent strain is present.

Consider whole genome sequencing MROs to identify linkages that may be separated by significant time periods and constitute part of an outbreak. Facilities should develop processes to monitor for related infections or colonisation.

Ensure patients are receiving appropriate treatment e.g., antimicrobials.

Isolate and test all contacts as directed by outbreak management team (or lead physician advice).

Do NOT cohort contacts with unexposed patients.

Ensure that contacts receive immunisation or chemoprophylaxis as appropriate.

Consider signage at entry of ward.

Consider advising patients and carers of outbreak (in person, via phone, or information sheet) while maintaining patient confidentiality.

Alert relevant staff to outbreak situation as required.